FAMILY THERAPY THEORY AND THE INTERVENTION PROCESS

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CHAPTER 2 FAMILY THERAPY THEORY AND THE INTERVENTION PROCESS

INTRODUCTION

Scientific theories define the boundaries of a discipline and provide parameters with regard to the subject matter and intervention process. In traditional theoretical approaches to intervention in human behaviour, primarily influenced by Freud, the individual and intrapsychic phenomena were the focus of study. Freud acknowledged the often powerful impact of family dynamics on the individual (e.g. the Oedipus complex) but nevertheless chose to focus intervention on intrapsychic conflicts rather than on family processes (Goldenberg & Goldenberg, 1996:6).
While recognising the significance of individual internal processes and behaviour, the contemporary, broader view of human problems focuses on the family context in which behaviour occurs. According to Anderson (1999:1), the development of family therapy, although not a unified theory or practice, confronts the basic assumptions on which individual approaches were based. Such an interpersonal perspective suggests that human behaviour is part of complex, interactional and recursive patterns taking place within the family, and emphasises the nature and role of individuals within primary relationships (Goldenberg & Goldenberg, 1996:8).
A specific paradigm (i.e. a point of view or philosophy that dominates scientific thinking) defines how a problem is viewed. However, unexplained problems stimulate scientific efforts to develop alternative perspectives and result in scientific revolution (Goldenberg & Goldenberg, 2000:11). According to Goldenberg and Goldenberg (1996:8) and Anderson (1999:2), just such a revolution occurred in the 1950s when family therapy began. Family therapy represented a new way of conceptualising human problems and of understanding human behaviour, resulting in a paradigm shift. Sluzki (in Goldenberg & Goldenberg, 2000:8) went so far as to consider family therapy an epistemological revolution in the human sciences. The family became the major focus of inquiry, problem explanation and treatment. Successful family therapy was deemed to alter restrictive, self-defeating and recurring patterns, and aimed at enriching family relationships.
Family therapy theory proposed a cybernetic epistemology, initially derived from mechanical systems theory on the regulation of feedback mechanisms operant in controlling both simple and complex systems (first-order cybernetics). Individual behaviour cannot be understood without attention to the context in which the behaviour occurs, i.e. the family. Symptoms function to stabilise the system and relieve family tension (Goldenberg & Goldenberg, 1996:12). According to Golann (1987:331), first-order cybernetics is the “…cybernetics of observed systems…”, whereas second-order cybernetics concerns the “…cybernetics of observing systems”.
Postmodern theorists advocate a second-order cybernetic view which contends that the individual in the family has a unique, separate, yet legitimate reality. Objective descriptions of families are merely social constructions that are agreed upon through social interaction. Symptoms are viewed as oppressive and the family are assisted to reclaim control and ‘reauthor’ their lives. This shift in thinking can be seen as a backlash against what were seen as the mechanistic, even manipulative techniques and strategies of first-order family therapists. Central to this perspective is the idea that one cannot observe or describe without modifying and being modified by the subject of observation (Golann, 1987:332).
Goldenberg and Goldenberg (1996:16) state that most family therapists subscribe to some form of cybernetic epistemology, but that a schism has developed between those operating from first-order models where the system is objectively observed and change is attempted from the outside, and those who see the family therapist as part of the system and a participant in constructing a new reality. Worden (1999:8), on the other hand, views systems theory as a foundation on which to build a new treatment and intervention modality, one that can compliment postmodernist ideas, suggesting a both/and rather than an either/or perspective.
In the literature that follows, the researcher will consider the historical origins of family therapy and trace its development from inception to the present day. The evolution of family therapy, beginning in the 1950s to the present day, will be explored, including the growth of family therapy within the South African context. A concise yet detailed review of the different schools of family therapy will be undertaken. These schools will be categorised according to the central focus of concern, namely theories that focus on behaviour patterns, on belief systems, and on context. Intervention requires consideration of a family’s readiness for change, and should be compatible with their culture, beliefs and values. Different forms of intervention will be considered, again using the categories of behaviour patterns, belief systems and context to provide some structure to the many interventions available to the family therapist. Finally, current literature on the notion of integration of modernist and postmodernist thinking will be explored.
The researcher would like the reader to note that the factual content of this chapter is deemed necessary in order to provide the theoretical basis for a better understanding of the epistemological shifts in family therapy. While it may appear to be ‘dry’ reading, it is an attempt to provide a consolidation of family therapy approaches and interventions, and documents the changes that have taken place over time.

AN HISTORICAL OVERVIEW OF FAMILY THERAPY

A discussion on the origins and history of family therapy follows.

Historical Roots of Family Therapy

According to Goldenberg and Goldenberg (1996:65), it is difficult to pinpoint accurately the beginning of a scientific endeavour. It appears that the 1950s is identified as the period when researchers and practitioners began to focus on the family’s role in the creation and maintenance of psychological disturbance in one or more family members. The cessation of World War II resulted in the reunification of families but escalated a number of social problems for which solutions were sought. People experienced stress as a result of delayed marriages, hasty wartime marriages, the loss of loved ones to death and a boom in the birth rate. Mental health professionals, previously focusing on the individual, were expected to deal with an array of problems associated with families (Gladding, 2002:64; Carr, 2000:48).
Rather than viewing the source of human problems or the appearance of symptoms in one family member as the outcome of one ‘sick’ person, the family therapist sees that individual as the symptom bearer, in other words, the person who expresses the family’s disequilibrium or dysfunction (Goldenberg & Goldenberg, 2000:15).
Change in the social environment, such as divorce and sexual liberation brought both freedom and conflict. Concomitant change in the economic, educational and work environments created new tensions for the family. Psychosocial intervention had become more accessible to a wider range of clients and practitioners from a number of disciplines, such as psychologists, social workers, pastoral counsellors and psychiatrists began to offer family intervention processes (Goldenberg & Goldenberg, 1996:66). The scope of intervention was broadened to include such issues as marital conflict, divorce, delinquency and problems with extended family members. Various forms of family intervention were deemed to be effective in treating many disorders, ranging from alcoholism to schizophrenia. More and more practitioners began to recognise the need for family intervention to alleviate family dysfunction and distress (Gladding, 2002:60; Carr, 2000:49).
Sprenkle, Blow and Dickey (1999:329) believe that the field of family (and marriage) therapy began as a “…maverick discipline…”, one that was “…oppositional, even defiant…” when compared to the prevailing psychotherapy of the times. Many of the field’s founding members were rebels, dynamic and charismatic, who created theories that fitted with their personalities. The various schools accentuated their differences, as well as a belief in the superiority of their approach.
According to Goldenberg and Goldenberg (1996:69), five scientific and clinical developments laid the foundation upon which family therapy was constructed. They are: psychoanalysis; general systems theory; the role of the family in schizophrenia etiology; marital counselling and child guidance; and group therapy techniques. Carr (2000:49-57) concurs, identifying these same developments in the history of the family therapy movement. In order to arrive at a better understanding of the interdisciplinary roots of family therapy, a brief exploration of these developments follows.

Psychoanalysis

Psychoanalytic theory and intervention was the work of Sigmund Freud and the dominant ideology in Western psychiatry after World War II, gaining ascendancy within various professions, namely, medical specialities, psychology, social work and sociology. Freud acknowledged the impact of family relationships on the personality formation of the individual, in particular the development of symptomatic behaviour (Goldenberg & Goldenberg; 1996:69). Psychoanalytic theory conceptualised the psychosexual development of children and the use of defence mechanisms as protection from anxiety. Therapeutically, Freud worked with individuals and intrapsychic phenomena rather than with interpersonal family dynamics. Contact with family members was strongly opposed, in the belief that it would ‘contaminate’ the therapist. This belief changed slowly, mainly for research purposes, and the family came to be seen therapeutically as a group.
Other significant psychoanalytic theorists, such as Alfred Adler and Harry Stack Sullivan began to stress interpersonal influences upon the individual, although it was Nathan Ackerman who has been credited with adapting psychoanalytic concepts to the study of the family (Goldenberg & Goldenberg, 1996:71).

 General systems theory and cybernetics

This theory, originally presented by biologist Ludwig von Bertalanffy, was an attempt to provide a comprehensive theoretical model encompassing all living systems, and a framework for understanding the interrelatedness of components of larger systems. The traditional view of the time (derived from physical science) was reductionist and linear, while systems theory focused on circular causality and process (Carr, 2000:59; Goldenberg & Goldenberg, 1996:73). In an article that defends linear causality, Dell (1986:513) believes that the insistence on the distinction between linear and circular causality breeds confusion in the mind of the therapist and how they should talk about families. In his view, linear causality refers to two “…distinct and incompatible domains; description (of experience) and explanation”. While concurring with Bateson’s claim that linear causality is not only impossible but an epistemological error, Dell believes that this does not account for what therapists know experientially, i.e. circular causality does not ‘describe’ our everyday experiences – Bateson’s epistemology ‘explains’ our experience.
Gregory Bateson, an anthropologist, is viewed by most authors as the single most influential figure in the history of family therapy (Carr, 2000:56). Bateson was not a practitioner of family therapy but researched and developed a unified framework within which mind and material substance could be coherently explained. He formed the Palo Alto group which included Haley, Weakland, Jackson and Fry, who together developed MRI brief therapy. Of particular importance to family therapy were the developments of the double bind theory of schizophrenia, communication as a multi-level process and cybernetics (Gladding, 2002:65; Carr, 2000:57).
The double bind theory proposed that schizophrenic behaviour occurs in families characterised by rigid and repetitive patterns of communication and interaction. Communication as a process conceptualises paradoxical interactions that maintain abnormal behaviour, an example being the double bind theory (Gladding, 2002:65; Carr, 2000:58; Goldenberg & Goldenberg, 2000:86).
Bateson’s group combined the concepts of systems theory with insights from cybernetics, the latter being founded by Norbert Weiner, as a framework in which to conceptualise family organisation and processes. From a family organisation perspective, the entire family influences and is influenced by the other members. At the same time a family is part of larger social systems, all being mutually influential (Carr, 2000:59). According to Bertrando (2000:89), the idea of Bateson’s cybernetic metaphor has not, as many believe, been to use the analogy of computer science to explain human behaviour within the family system. Rather it is descriptive language to describe human interaction, and possibly to free Bateson and his followers from the psychoanalytic language of the day, and specify their own approach.
Systems theory was historically significant to the emerging family therapy movement, emphasising multiple causality in dysfunction, rather than defining problems as individual intrapsychic conflicts. Of importance too, was the shift from the study of the mind to the study of observable manifestations and behaviours in interpersonal relationships.
General systems theory addressed the question (Carr, 2000:60-67): How is it that the whole is more than the sum of its part?
Cybernetics addressed the question: How do systems use feedback to remain stable or adapt to new circumstances?
Significant aspects of general systems theory and cybernetics include seeing the family as a system with boundaries, organised into subsystems; the boundary must be semi permeable to allow for adaptation and survival; the behaviour of each family member determines the patterns of interactions that connect the family; these patterns are recursive and may be associated with problematic behaviour; the patterns are circular in causality; family processes both prevent and promote change (i.e. homeostasis and morphogenesis); within the family one member (the identified patient) may develop problematic behaviour which functions to maintain family homeostasis; negative feedback maintains homeostasis and sub-serves morphogenesis; individuals and factions within the systems may show symmetrical and complementary behaviour patterns – exclusive engagement in either pattern may threaten the integrity of the family; positive and negative feedback is “…news of difference” that may enhance change; and, a distinction is made between first- and second-order change (Carr, 2000:66). In the former, the rules of interaction within the system remain unchanged but there may be some alteration in the way they are applied – in the latter the rules within the system change; a distinction is made between first- and second-order cybernetics – the former assumes the therapist is an objective outsider of the family system – the latter assumes the therapist, with the family, forms a new therapeutic system which is influenced by homeostasis and morphogenesis that may impede change or lead to problem resolution; recursive patterns in one part of the system replicate isomorphically in other parts of the system – patterns of family interaction may be replicated across generations and even across social systems. A theory of multigenerational transmission is discussed later in the chapter.

The role of the family and schizophrenia

Early studies into the role of family dynamics in the development of psychopathology focused on deficient parenting, specifically the schizophrenogenic mother (cold, domineering, rejecting and possessive) and the detached, ineffectual father, in creating and maintaining pathological behaviour. This was later replaced with the view that pathological interactions occurred within the family context and the connection between family environment and schizophrenia remains at the forefront of family systems research (Carr, 2000: 57; Goldenberg & Goldenberg, 1996:75).

ACKNOWLEDGEMENTS 
SUMMARY 
KEYWORDS 
OPSOMMING 
SLEUTELWOORDE 
TABLE OF CONTENTS 
LIST OF TABLES 
CHAPTER 1: GENERAL ORIENTATION
1.1 INTRODUCTION
1.2 PROBLEM FORMULATION
1.3 PURPOSE, GOAL AND OBJECTIVES OF THE RESEARCH STUDY
1.3.1 Purpose
1.3.2 Goal
1.3.3 Objectives
1.3.3.1 Literature study
1.3.3.2 Empirical study
1.4 HYPOTHESIS/RESEARCH QUESTION/STATEMENT
1.5 RESEARCH APPROACH
1.6 TYPE OF RESEARCH
1.7 RESEARCH DESIGN AND METHODOLOGY
1.7.1 Data Analysis
1.7.1.1 Data collection and recording
1.7.1.2 Managing data
1.7.1.3 Reading and writing memos
1.7.1.4 Describing, classifying and interpreting
1.7.1.5 Representing and visualising
1.8 PILOT STUDY
1.8.1 Pre-test of Questionnaire/Measuring Instrument
1.8.2 Feasibility of the Study
1.9 RESEARCH POPULATION, SAMPLE AND SAMPLING METHOD
1.9.1 Research Population
1.9.2 Delimitation of the Sample
1.9.3 Sampling Methods
1.9.4 Ethical Aspects
1.9.4.1 Harm to respondents
1.9.4.2 Informed consent/voluntary participation
1.9.4.3 Anonymity, privacy and confidentiality
1.9.4.4 Deception of subjects
1.9.4.5 Actions and competence of the researcher
1.9.4.6 Cooperation with contributors
1.9.4.7 Release or publication of findings
1.9.4.8 Debriefing of respondents
1.10 DEFINITION OF KEY CONCEPTS
1.10.1 Epistemology
1.10.2 Authentic/Self
1.10.3 Reflexivity
1.10.4 Family Therapy Theory and Intervention
1.10.5 Family Therapist/Counsellor/Practitioner
1.10.6 Postmodern Concepts
1.11 CONTENTS OF THE RESEARCH REPORT
CHAPTER 2: FAMILY THERAPY THEORY AND THE INTERVENTION PROCESS
2.1 INTRODUCTION
2.2. AN HISTORICAL OVERVIEW OF FAMILY THERAPY
2.2.1 Historical Roots of Family Therapy
2.2.1.1 Psychoanalysis
2.2.1.2 General systems theory and cybernetics
2.2.1.3 The role of the family and schizophrenia
2.2.1.4 Marital counselling and child guidance
2.2.1.5 Group therapy
2.3 THE EVOLUTION OF FAMILY THERAPY: 1950 – PRESENT
2.3.1 The 1950s
2.3.2 The 1960s
2.3.3 The 1970s
2.3.4 The 1980s
2.3.5 The 1990s
2.3.6 The History and Evolution of Family Therapy in South Africa
2.4 THEORIES OF FAMILY THERAPY
2.4.1 Theories that Focus on Behaviour Patterns
2.4.1.1 MRI brief therapy
2.4.1.2 Strategic family therapy
2.4.1.3 Structural family therapy
2.4.1.4 Cognitive-behavioural family therapy
2.4.1.5 Functional family therapy
2.4.2 Theories that Focus on Belief Systems
2.4.2.1 Epistemology: positivism, constructivism, social constructionism, modernism and postmodernism
2.4.2.2 Constructivist family therapy
2.4.2.3 Milan systemic family therapy
2.4.2.4 Social constructionist developments
2.4.2.5 Solution-focused therapy
2.4.2.6 Narrative therapy
2.4.2.7 A postmodern feminist approach
2.4.2.8 Existential family therapy
2.4.3 Theories that Focus on Context
2.4.3.1 Transgenerational family therapy
2.4.3.2 Psychoanalytic family therapy
2.4.3.3 Attachment-based therapies
2.4.3.4 Experiential family therapy
2.4.3.5 Multisystemic family therapy
2.4.3.6 Psychoeducational family therapy
2.4.3.7 Multi-cultural considerations in family therapy
2.5 INTERVENTION
2.5.1 Interventions for Behaviour Patterns
2.5.2 Interventions for Belief Systems
2.5.3 Interventions for Contexts
2.6 INTEGRATION
2.7 SUMMARY
CHAPTER 3: THE REFLECTING TEAM IN FAMILY THERAPY
3.1 INTRODUCTION
3.2 DIALOGUE IN THE THERAPEUTIC CONVERSATION
3.3 TOM ANDERSEN’S REFLECTING PROCESSES
3.4 ALTERNATIVE STORIES IN USING REFLECTING TEAMS
3.5 THE REFLECTING TEAM PROCESS IN TRAINING
3.6 PEER REFLECTING TEAMS
3.7 TRAINING IN REFLECTIVE THINKING
3.8 SUMMARY
CHAPTER 4: THE DEVELOPMENT AND USE OF THE SELF IN FAMILY THERAPY
4.1 INTRODUCTION
4.2 DEVELOPING A SELF
4.3 ON BECOMING A FAMILY THERAPIST
4.4 THE RELATIONSHIP BETWEEN CHOICE OF THEORY AND THE SELF
4.5 THE THERAPEUTIC RELATIONSHIP
4.6 ENHANCING SELF AWARENESS AND REFLEXIVITY
4.7 BURNOUT
4.8 SUMMARY
CHAPTER 5: QUALITATIVE RESEARCH FINDINGS
5.1 INTRODUCTION
5.2 RESEARCH METHODOLOGY
5.3 DATA COLLECTION, PROCESSING, ANALYSING AND INTERPRETATION
5.4 QUALITATIVE RESEARCH FINDINGS
5.5 SUMMARY
CHAPTER 6: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
6.1 INTRODUCTION
6.2 GENERAL ORIENTATION
6.3 LITERATURE STUDY
6.4 QUALITATIVE RESEARCH FINDINGS
6.5 RECOMMENDATIONS
BIBLIOGRAPHY 
ANNEXURE
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